Laparotomy Incision Research Articles

Benefits of cyanoacrylate mesh closure following exploratory laparotomy in horses.

Skin closure of laparotomy incisions using topical 2-octyl cyanoacrylate (2-OCA) mesh provides a secure bactericidal barrier in humans, which may reduce therisk of postoperative incisional complications. However,the benefits ofusingthismeshhave not been objectively assessed in horses. From 2009 to 2020, three methods of skin closure were used following laparotomy for acute colic, including metallic staples (MS), suture (ST) and cyanoacrylate mesh (DP). The closure method was not randomised. Owners were contacted 3 months or more afterthesurgerytorecordanypostoperative complicationsthatoccurred. For each method of closure, the rates of surgical site infection (SSI) and herniation were recorded, as well as surgical time and treatment costs, including those for incisional complications. Chi-square testing and logistic regression modelling were used to assess differences between the groups. A total of 110 horses were recruited (45 in the DP group, 49 in the MS group and 16 in the ST group) The overall rate of SSI was 15.5%, with rates of 8.9%, 18.4% and 25% for the DP, MS and ST groups, respectively (p = 0.23). In addition, incisional hernias developed in 21.8% of cases, with 8.9%, 34.7% and 18.8% of horses in the DP, MS and ST groups, respectively, being affected (p = 0.009). The median total treatment cost did not differ significantly between groups (p = 0.47). This was a retrospective study with non-randomised choice of closure method. No significant differences in the rate of SSI or overall cost wwere demonstrated between treatment groups. However, MS was associated with a higher rate of hernia formation than DP or ST. Despite increased capital cost, 2-OCA proved to be a safe skin closure method in horses and was no more expensive than DP or ST by the time visits to remove sutures/staples and treat infections were factored in.

Does colonization with MRSA, ESBL - producing Enterobacteriaceae, and/or Acinetobacter baumannii - increase the risk for postoperative surgical site infection?

Evaluation of the role of indicator pathogens in equine surgical site infection (SSI) and other infection-promoting factors. Cross-sectional study. Horses presenting with an open injury or surgical colic during 1.5 years. A nasal swab and a faecal sample were collected from every patient upon admission. Furthermore, a wound swab was collected from wounds of injured horses. Details on the wounds and procedures were documented. Laparotomy incisions and injuries were monitored for signs suggesting infection. In total, 156 horses presented because of a surgical colic (n=48) or open injuries (n=108). Thirteen surgical colic patients and three injured horses did not survive beyond 24h, and four injured horses were discharged from the clinic at the day of admission. SSIs occurred in 31 (30.7%) injured horses and 11 (31.4%) horses after laparotomy. Regarding injuries, general anaesthesia increased the risk of developing a WI compared to sedation. Indicator pathogens were cultured from 29/42 SSI. In total, 10/11 infected laparotomy incisions and 19/31 injuries with SSI tested positive for multidrug-resistant pathogens (MDRPs) . Indicator pathogens were not detected at admission in any of the horses that developed incisional SSIs after laparotomy but were detected in two of the injured horses that developed SSIs. MDRPs were identified in almost 70% of the SSI. Less than 5% of the affected animals were colonized with the same pathogen before admission, indicating that colonization with MDR pathogens is only one of the crucial factors for the development of SSI. Colonization with MDRP seems not to predispose horses to MDR SSIs.

Abdominal and robotic sacrocolpopexy costs following implementation of enhanced recovery after surgery.

To compare perioperative costs and morbidity between open and robotic sacrocolpopexy after implementation of enhanced recovery after surgery (ERAS) pathway. The present retrospective cohort study of patients undergoing open or robotic sacrocolpopexy (January 1, 2014, through November 30, 2017) used an ERAS protocol with liposomal bupivacaine infiltration of laparotomy incisions. Primary outcomes were costs associated with index surgery and hospitalization, determined with Medicare cost-to-charge ratios and reimbursement rates and adjusted for variables expected to impact costs. Secondary outcomes included narcotic use, length of stay (LOS), and complications from index hospitalization to postoperative day 30. For the total of 231 patients (open cohort, 90; robotic cohort, 141), the adjusted mean cost of robotic surgery was $3239 higher compared with open sacrocolpopexy (95% confidence interval [CI] $1331-$5147; P < 0.001). Rates were not significantly different for intraoperative complications (robotic, 4.3% [6/141]; open, 5.6% [5/90]; P=0.754), 30-day postoperative complications (robotic, 11.4% [16/141]; open, 16.7% [15/90]; P=0.322), or readmissions (robotic, 5.7% [8/141]; open, 3.3% [3/90]; P=0.535). The percentage of patients dismissed on postoperative day 1 was greater in the robotic group (89.4% [126/141] vs. 48.9% [44/90], P < 0.001). Decreased LOS associated with ERAS provided significant cost savings with open sacrocolpopexy versus robotic sacrocolpopexy without adverse impacts on perioperative complications or readmissions.

Retroperitoneal-first dissection approach at the dorsal space for a huge serous cystic neoplasm of the pancreatic tail: a case report

BackgroundLarge tumors of serous cystic adenomas in the pancreatic body-to-tail severely compress the surrounding organs and retroperitoneal space.Case presentationWe present a unique surgical challenge for distal pancreatectomy (DP). We present the case of a patient who had a massive mass lesion measuring more than 20 cm in size that had been misdiagnosed as a retroperitoneal tumor by the previous hospital. However, an expert radiologist at our institute diagnosed serous cystadenoma of the pancreas based on imaging characteristics. We decided to perform retroperitoneal space first dissection using a small incision because we were concerned about tumor infiltration or compressive adhesions in important retroperitoneal vessels. We safely attempted distal pancreatectomy by limiting the laparotomy incision step-by-step while securing the main vascular injury of the retroperitoneum. In addition to the ordinary cooperation with urological surgeons, this technique is referred to by the concept of retroperitoneal procedures for minimally invasive surgery in urology.ConclusionsThis approach is useful for lifting resected specimens by prior and wide retroperitoneal dissection, which may lead to safety and the prevention of unexpected vascular injury.

Application of preventive negative pressure therapy on midline laparotomy incisions in horses – a retrospective study

Application of preventive negative pressure therapy on midline laparotomy incisions in horses – a retrospective study

Successful use of differential target multiplexed spinal cord stimulation for chronic postsurgical abdominal pain

Recent advances in stimulation techniques have improved the efficacy and expanded the applicability of spinal cord stimulation (SCS). Among these techniques, there are no reports on the efficacy of differential target multiplexed (DTM) SCS for chronic postsurgical pain (CPSP) after abdominal surgery. Therefore, we present the successful use of DTM SCS for CPSP after distal pancreatectomy. A 49-year-old man with hypertension and severe chronic low back pain presented with neuropathic CPSP involving the left abdomen in the area of a laparotomy incision. His pain was refractory to conservative treatment and was rated 10 on a numerical rating scale (NRS). He underwent permanent implantation of a pulse generator after a 14-day trial stimulation. Chronic postsurgical pain was well controlled (NRS 1-2) at a 3-month follow-up with DTM SCS. Differential target multiplexed SCS can be a new treatment option for neuropathic CPSP that is resistant to conservative treatment. It is important to further examine the characteristics of CPSP and identify appropriate candidates for the successful use of DTM SCS.

Evaluation of direct intramural injection to the bladder wall as a method for developing orthotopic tumor models.

Bladder cancer poses a great burden on society and its high rate of recurrence and treatment failure necessitates use of appropriate animal models to study its pathogenesis and test novel treatments. Orthotopic models are superior to other types since they provide a normal microenvironment. Four methods are described for developing bladder cancer models inside the animal's bladder. Direct intramural injection is one of these methods and is widely used. However, its efficacy in model development has not yet been studied. We aimed to evaluate the efficacy and success rate of the direct intramural injection method of developing an orthotopic model for the study of bladder cancer. Tumor cell lines were prepared in four microtubes. Aliquots of 200 × 103 cells were injected through a 27 gauge needle into the ventral wall of the bladders of 4 male and 4 female BALB/c mice following a midline 1cm laparotomy incision. In addition, 1 million cells from each microtube were injected into the flanks of control mice. To prevent infection and alleviate pain, 5mg/kg enrofloxacin and 2.5mg/kg flunixin meglumine, respectively, were injected subcutaneously. Tumors formed in all mice, resulting in 100% take rate and zero post-operation mortality. Surgery time was ≤15 min per mouse. In two mice, tumors were found in the peritoneal space as well. Direct intramural injection is a rapid, reliable, and reproducible method for developing orthotopic models of bladder cancer. It can be done on both male and female mice and only requires readily available surgical tools. However, needle track can result in cell spillage and peritoneal tumors.

Continuous Intravenous Lidocaine for Acute Pain Management Post Laparotomy Surgery: A Case Series

Introduction: Acute post-operative pain can lead to prolonged use of opioids and progress to chronic pain. Multimodal analgesic approaches have replaced the use of opioid monotherapy, but opioid use continues and contributes to inadequate acute pain management. Intravenous lidocaine has analgesic, anti-hyperalgesic, and anti-inflammatory effects. This study aims to describe post-operative pain management using intravenous lidocaine.&#x0D; Case presentation: There were two cases. The first was a 32-year-old female patient with suspected interrupted ectopic pregnancy who underwent emergency laparotomy under spinal anesthesia and, after 2 hours, was converted to general anesthesia. Postoperatively, the analgesic lidocaine was given as a 52 mg intravenous bolus followed by a continuous 36 mg/hour/syringe pump. The patient's VAS scale was initially 2/10, and on the third day, 1/10 continued treatment. In the second case, an 18-year-old male patient with suspected acute appendicitis underwent a midline incision laparotomy appendectomy with spinal anesthesia. Postoperatively, lidocaine was given a slow bolus of 75 mg intravenously, finished in 5 minutes, then 50 mg/hour/intravenously. The patient's VAS scale was initially 2-3/10 until on the third day. He was transferred to a room with a VAS of 1-2/10.&#x0D; Conclusion: Lidocaine is an effective intravenous analgesic to treat acute pain after laparotomy surgery. Administration of relatively low doses can achieve post-operative analgesia without concern for toxicity.

Outcomes after natural orifice extraction vs conventional specimen extraction surgery for colorectal cancer: A propensity score-matched analysis.

Natural orifice specimen extraction (NOSE) via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision. Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma. These techniques reduce the surgical wound size as well as the risk of incision-related morbidity. To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery. Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified. Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction Surgery for colorectal cancer. Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded. The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020. Matching was performed in the ratio of 1:4 based on age, gender, type of resection, and p - tumor node metastasis staging. Over the eight-month study duration, 14 consecutive cases (nine female, five male) of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer. Median age and body mass index were 70 (range 43-82) years and 24.1 (range 20.0-31.7) kg/m2 respectively. Six patients underwent transanal NOSE and eight had transvaginal NOSE. Median operative time, intraoperative blood loss and postoperative length of stay were 208 (range 165-365) min, 30 (range 10-150) mL and 3 (range 2-6) d respectively. Two (14%) suffered minor postoperative compilations not attributable to the NOSE procedure. Median follow-up duration was 12 (range 8-15) mo. No instances of mortality, local or distant disease recurrence were recorded in this cohort. Compared to the conventional surgery cohort of 56 patients, the 3-port NOSE cohort had significantly quicker mean return of bowel function (2.6 vs 1.2 d, P < 0.001), reduced postoperative pain and patient-controlled analgesia use, and decreased length of hospital stay (6.4 vs 3.4 d, P < 0.001). There were no statistical differences in surgical duration and perioperative complication rates between the NOSE and non-NOSE cohorts. 3-port laparoscopic colorectal surgery with NOSE is a feasible technique, augmenting the minimally invasive nature of surgery and producing good outcomes. Appropriate patient selection and expertise in conventional laparoscopy are required.

P-139 THE EFFECTS OF THE INCISION TYPE ON INCISIONAL HERNIA RESULTS OF LIVING DONOR LIVER TRANSPLANT; SINGLE CENTER EXPERIENCE

Abstract Aim We aimed to assess the effects of the chosen incision type on postoperative hernia rates of liver transplantation in this paper. Material-Methods During the period between the 5th September 2018 and 31st March 2022, total 210 liver transplantations were performed in the Liver Transplantation Center of Koç University Hospital. 96 pediatric and 10 deceased donor transplantations were excluded. Living donor liver transplantation (LDLT) cases in only adults were included in the trial. Total 104 patients were included. Patients divided into two groups in the manner of chosen laparotomy incision during the operation. Reverse T incisions (Group A, n=68) and Makuuchi incisions (Group B, n=36) were performed in our center during the trial period. Minimum 3 month-follow up period was performed. Results Demographic data (Table 1) was similar in both groups. Operation and warm ischemia durations were longer in Group B (Table 2). Postoperative immunosuppressive regimens were same protocols contains tacrolimus and prednisolone. Surgical site infection rates, relaparotomy rates, postoperative blood transfusion rates, biliar, vascular and pulmonary complication rates were also similar in both groups (Table 3). While 11 patients diagnosed with incisional hernia in Group A (%16,2), 2 patients diagnosed with incisional hernia in Group B (%5,6, p=0,212). Conclusion Although Makuuchi incision seems to be safer in manner of hernia rates, this couldn't be proved by statistically significance as a result of this retrospective analysis of a single center. The necessity of prospective designed trials is obvious in order to obtain more reliable results.

Anesthesia and pain management of pediatric cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has shown to improve survival in patients with extensive or refractory abdominal tumors of many different histologies. Postoperative pain control can be challenging as the surgical procedure is performed through a midline laparotomy incision from xiphoid to symphysis pubis, and patients are usually nothing by mouth for the first 8-10 postoperative days. We present the anesthetic management and postoperative pain control strategies for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using a multimodal, opioid-sparing, and total intravenous anesthetic technique with a tunneled thoracic epidural. A single institution retrospective review of anesthetic management, intraoperative fluid and blood administration, and postoperative pain control for pediatric patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy between July 2018 and December 2020 was conducted. We employed a novel anesthetic and analgesia protocol consisting of premedication with gabapentin followed by intraoperative infusions of propofol, dexmedetomidine, ketamine, and cisatracurium. A tunneled thoracic epidural catheter was placed for management of pain. We reviewed and analyzed the first 25 patient records. The most common diagnosis was desmoplastic small round cell tumor (n=12). Median age of patients was 14 years (range 21 months-22 years). All patients were extubated in the operating room and no patients required reintubation. There were no incidences of acute kidney injury. Epidural infusions were used for a median of 8 days (range 2-14 days). Median postoperative intravenous opioid use (morphine equivalent) through postoperative day 10 was 0.02 mg/kg/day (range 0-0.86 mg/kg/day) administered for a median of 2 days (range 0-17 days). Nine patients (36%) did not require any intravenous opioids in the postoperative period. Utilizing a multimodal, opioid-sparing, total intravenous anesthetic technique in conjunction with a tunneled thoracic epidural catheter, we were able to avoid the need for postoperative mechanical ventilation and minimize both intraoperative and postoperative opioid requirements.

A single-blind randomised controlled trial comparing clinical equivalence of Trulon® and Ethilon® polyamide sutures for the skin closure following laparotomy incisions

BackgroundLaparotomy is a common procedure to gain access to the peritoneal cavity, for obstetrics, gynecological, and digestive system-related surgeries. Wound infection is among other complications of laparotomy. This study compared the rate of wound infection post-laparotomy skin closure using Trulon® and Ethilon® polyamide sutures. MethodsThis multicentric, prospective, two-arm, parallel-group, randomized (1:1), single-blind study (CTRI/2020/09/027978) was conducted between January and July 2021, and included 102 women undergoing laparotomy-based obstetric/gynecological procedures. The primary endpoint, incidence of wound infection [superficial and deep surgical site infection(SSI)] occurring within 12 weeks of the surgery was compared between two treatment groups, Trulon® (n = 50) and Ethilon® (n = 52). The secondary endpoints, incidence of wound dehiscence, suture sinus, seroma, hematoma, skin disruption, suture loosening, re-suturing, duration of surgery, suture removal, hospital stay, intraoperative suture handling parameters, pain score, return to normal day-to-day activities, modified Hollander cosmesis score, subject satisfaction score, and adverse events were also evaluated. ResultsNon-significant differences were observed in the incidence of SSI, wound dehiscence, suture sinus, seroma, hematoma, skin disruption, suture loosening, re-suturing, intraoperative handling parameter (except ease of passage), operative time, hospital stay, suture removal duration, pain score, time to return to day-to-day activities, modified Hollander cosmesis score, and subject satisfaction score between the two groups. ConclusionTrulon® and Ethilon® polyamide sutures are clinically equivalent. For abdominal skin closure following laparotomy both the sutures deliver a lower chance of infection, minimal pain, higher satisfaction, and cosmesis score. Registration of researchThis trial is registered prospectively at Clinical Trial Registry of India (CTRI Reg. No: CTRI/2020/09/027978; Registered on: 23/09/2020).

Abdominal Orta Hat İnsizyonlarda Elektrokoter ile Bistüri Kullanım Sonuçlarının Karşılaştırılması

Objective: Scalpel is the conventional instrument for laparotomy incisions. Electrocautery, on the other hand, can offer potential advantages such as blood loss, incision time, postoperative pain. In this study, we aimed to compare the clinical results of electrocautery and scalpel in abdominal midline surgical incisions.&#x0D; Method: 146 cases who underwent elective abdominal midline incision between January 2020 – December 2021 were included in the study. The patients were divided into two randomized groups as electrocautery (n: 78) and scalpel (n: 68). The incision dimensions, incision time and blood loss during incision were noted intraoperatively. Postoperative pain and wound infection were recorded.&#x0D; Results: The age and sex distribution was similar in the two groups. Incision time(seconds) in the electrocautery group (35.4±18.1) (57.6±25.3) was significantly shorter compared with the time in the scalpel group(p

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

A Biomechanical Analysis of Prophylactic Mesh Reinforced Porcine Laparotomy Incisions

IntroductionResearch indicates that prophylactic mesh may help prevent incisional hernia after laparotomy, but best practice patterns in these situations are still evolving. Here, we compare the failure loads (FLs) and biomechanical stiffness (BMS) of 35 porcine abdominal wall laparotomy incisions reinforced with meshes of various widths and fixation distances using biomechanical testing. MethodsIn each specimen, a 10-cm incision was made and closed using continuous 1-0 Maxon suture. Specimens were randomized to mesh width (none, 2.5 cm, 3 cm, 4 cm, 6 cm, 8 cm) and tack separation (1.5 cm, 2 cm apart) and the meshes secured in an onlay fashion. Cyclic loads oscillating from 15 N to 140 N were applied to simulate abdominal wall stress, and the specimens subsequently loaded to failure. FLs (N) and BMS (N/mm) were comparatively analyzed. ResultsAll specimens failed via suture pull-through. FLs and BMS were lowest in specimens with suture-only (421.43 N; 11.69 N/mm). FLs and BMS were significantly higher in 4-cm mesh specimens (567.51 N) than those with suture, 2.5-cm, and 3.0-cm mesh (all P < 0.05). FLs in specimens with a greater number of tacks were consistently higher in meshes of similar sizes, although these did not reach significance. ConclusionsA 4-cm mesh reenforcement was superior to suture-only and smaller meshes at preserving strength in laparotomy closure in a porcine model but larger meshes (6 cm, 8 cm) did not provide an additional benefit. Meshes with more fixation points may be advantageous, but additional data are needed to make definitive conclusions.

The Role of Surgical Expertise and Surgical Access in Retroperitoneal Sarcoma Resection - A Retrospective Study.

BackgroundRetroperitoneal sarcoma (RPS) is a rare disease often requiring multi-visceral and wide margin resections for which a resection in a sarcoma center is advised. Midline incision seems to be the access of choice. However, up to now there is no evidence for the best surgical access. This study aimed to analyze the oncological outcome according to the surgical expertise and also the incision used for the resection.MethodsAll patients treated for RPS between 2007 and 2018 at the Department of Visceral Surgery and Medicine of the University Hospital Bern and receiving a RPS resection in curative intent were included. Patient- and treatment specific factors as well as local recurrence-free, disease-free and overall survival were analyzed in correlation to the hospital type where the resection occurred.ResultsThirty-five patients were treated for RPS at our center. The majority received their primary RPS resection at a sarcoma center (SC = 23) the rest of the resection were performed in a non-sarcoma center (non-SC = 12). Median tumor size was 24 cm. Resections were performed via a midline laparotomy (ML = 31) or flank incision (FI = 4). All patients with a primary FI (n = 4) were operated in a non-SC (p = 0.003). No patient operated at a non-SC received a multivisceral resection (p = 0.004). Incomplete resection (R2) was observed more often when resection was done in a non-SC (p = 0.013). Resection at a non-SC was significantly associated with worse recurrence-free survival and disease-free survival after R0/1 resection (2 vs 17 months; Log Rank p-value = 0.02 respectively 2 vs 15 months; Log Rank p-value < 0.001).ConclusionsResection at a non-SC is associated with more incomplete resection and worse outcome in RPS surgery. Inadequate access, such as FI, may prevent complete resection and multivisceral resection if indicated and demonstrates the importance of surgical expertise in the outcome of RPS resection.

V04-09 UNDOUBLED BLADDER IN THE SAGITTAL PLANE WITH ONE EXSTROPHIC BLADDER: A CASE REPORT ON RECONSTRUCTIVE TECHNIQUE

You have accessJournal of UrologyCME1 May 2022V04-09 UNDOUBLED BLADDER IN THE SAGITTAL PLANE WITH ONE EXSTROPHIC BLADDER: A CASE REPORT ON RECONSTRUCTIVE TECHNIQUE Wietse Claeys, Caroline Jamaer, Camille Berquin, Irina Verbakel, Achilles Ploumidis, Erik Van Laecke, Piet Hoebeke, and Anne-Françoise Spinoit Wietse ClaeysWietse Claeys More articles by this author , Caroline JamaerCaroline Jamaer More articles by this author , Camille BerquinCamille Berquin More articles by this author , Irina VerbakelIrina Verbakel More articles by this author , Achilles PloumidisAchilles Ploumidis More articles by this author , Erik Van LaeckeErik Van Laecke More articles by this author , Piet HoebekePiet Hoebeke More articles by this author , and Anne-Françoise SpinoitAnne-Françoise Spinoit More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Exstrophy-Epispadias complex is a spectrum of rare congenital malformations that can involve multiple organ systems. It can range from a simple glandular defect to a complete multisystem malformation with cloacal exstrophy and musculoskeletal diastasis. We report on the case of an adult woman who was born with an exstrophy variant with bladder and urethral duplication in the sagittal plane. The aim of our study was to report our reconstructive approach in this rare case of bladder exstrophy with maximum use of available tissues. METHODS: A 27-year old female patient was referred to our center for the complaint complete incontinence since birth. Upon first clinical examination, we discovered an exstrophic bladder with blind ending ureteral orifices. Further evaluation revealed a urethral meatus caudal to the exstrophic bladder plate. Cystoscopy revealed a second non-exstrophic bladder in the sagittal plane with complete incontinence due to a broad open bladder neck. This bladder contained 2 orthotopic ureters with normal retrograde urethrography. Vaginoscopy revealed a short and small vaginal channel and an arcuate uterus. Plain radiography of the pelvis showed a diastasis of 5 centimeters. CT scanning could not reveal any aberrant anatomy in the upper urinary tract. Genetic testing showed a normal 46XX karyotype. A laparotomy incision is performed and the exstrophic bladder plate is dissected caudally up to the point where a ventral inlay in the non-exstrophic bladder can be performed as augmentation tissue. A Mitchell-type bladder neck reconstruction with fascia sling interposition is performed. Since we do not know if this non-exstrophic bladder will be capable of emptying or if the bladder neck reconstruction will remain patent, we chose for the interposition a continent Mitrofanoff-type vesicostomy. Genital reconstruction with re-anastomosis of the urethral meatus between the inner labia is performed. The patient was thought self-catheterization through the appendiceal channel. At this point the patient can hold around 250 ml in the bladder. She catheterizes 5 times a day and once at night. She is completely dry. RESULTS: We present our reconstructive technique in a step-by-step-video guide. Our main focus was to achieve continence by maximal use of available tissues with the best possible quality of life for the patient. CONCLUSIONS: No surgical technique will be suitable for all these varying anomalies. Therefore, reconstructive surgeons need to tailor their approach based on available tissues and functional goals. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e369 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wietse Claeys More articles by this author Caroline Jamaer More articles by this author Camille Berquin More articles by this author Irina Verbakel More articles by this author Achilles Ploumidis More articles by this author Erik Van Laecke More articles by this author Piet Hoebeke More articles by this author Anne-Françoise Spinoit More articles by this author Expand All Advertisement PDF DownloadLoading ...

Study of Different Methods of Midline Laparotomy Incision Closure and their Outcomes

Background: The closure of such a laparotomy wound is important to minimize the postoperative complications like wound pain, infection, dehiscence and incisional hernia. Aims: The objectives of this study was to study the various techniques of midline laparotomy incision closure and their outcomes like wound dehiscence, wound infection and incisional hernia up to six months. Materials and Methods: A total of 100 patients who were operated for midline laparotomy were included as subject material after they satisfied the inclusion and exclusion criteria. Results: Most common indication of laparotomy in the study was gastric ulcer perforation. Incidence rate of surgical site infection, wound dehiscence and incisional hernia was lower in cases of smaller bite length. Incidence rate of surgical site infection wound dehiscence and incisional hernia was lower with continuous suturing. Conclusion: The study results showed that best technique for midline laparotomy incision closure is small bite continuous suturing with mass closure. The small bites technique with continuous suturing showed better results than small bite technique with interrupted suturing. Present study thus recommends that small bite continuous suturing with mass closure should be considered as the standard closure technique for midline incisions.

Mass Closure Comparison with Layered Closure in Midline Laparotomy Incisions

Incision and suturing abdominal wall is a common surgical practice and different methods of repairing and applying have aroused great interest among surgeons. This study aims to compare mass closure and layered closure in midline laparotomy incisions. This prospective comparative study was conducted in the surgical ward of Nangarhar University Hospital on 40 patients from June 2020 to June 2021. A and B were assigned to all of the patients randomly. Twenty patients received bulk closure and other twenty underwent multilayer closure. The time of surgery, wound infection, abdominal rupture, and other consequences were all compared across all patients. Patients were followed on Day 2, day 4, day 8, day 12, monthly for 3 months and after 6 months. The rate of wound infection in layered (group B) is higher as compared to mass closure (group A). In general, the wound infection rate in the multilayer closure group was 2 cases (10%) and 1 case (5%) in the mass closure group. In layered closure, event ratio was 10%, while in mass closure it was 5%. In multilayer closure, a buttonhole hernia was detected in one case (5%) and none in mass closure. In layered closure, sinus development was seen in two cases (10%), but not in mass closure. The method of closure by mass to close the midline laparotomy incisions is simple, easy to perform, and safer than Layered closure.

Direct to OR resuscitation of abdominal trauma: An NTDB propensity matched outcomes study.

Direct to operating room resuscitation (DOR) is used by some trauma centers for severely injured trauma patients as an approach to minimize time to hemorrhage control. It is unknown whether this strategy results in favorable outcomes. We hypothesized that utilization of an emergency department operating room (EDOR) for resuscitation of patients with abdominal trauma at an urban Level I trauma center would be associated with decreased time to laparotomy and improved outcomes. We included patients 15 years or older with abdominal trauma who underwent emergent laparotomy within 120 minutes of arrival both at our institution and within a National Trauma Data Bank sample between 2007 to 2019 and 2013 to 2016, respectively. Our institutional sample was matched 1:1 to an American College of Surgeons National Trauma Databank sample using propensity score matching based on age, sex, mechanism of injury, and abdominal Abbreviated Injury Scale score. The primary outcome was time to laparotomy incision. Secondary outcomes included blood transfusion requirement, intensive care unit (ICU) length of stay (LOS), ventilator days, hospital LOS, and in-hospital mortality. Two hundred forty patients were included (120 institutional, 120 national). Both samples were well balanced, and 83.3% sustained penetrating trauma. There were 84.2% young adults between the ages of 15 and 47, 91.7% were male, 47.5% Black/African American, with a median Injury Severity Score of 14 (interquartile range [IQR], 8-29), Glasgow Coma Scale score of 15 (IQR, 13-15), 71.7% had an systolic blood pressure of >90 mm Hg, and had a shock index of 0.9 (IQR, 0.7-1.1) which did not differ between groups (p > 0.05). Treatment in the EDOR was associated with decreased time to incision (25.5 minutes vs. 40 minutes; p ≤ 0.001), ICU LOS (1 vs. 3.1 days; p < 0.001), transfusion requirement within 24 hours (3 units vs. 5.8 units packed red blood cells; p = 0.025), hospital LOS (5 days vs. 8.5 days, p = 0.014), and ventilator days (1 day vs. 2 days; p ≤ 0.001). There were no significant differences in in-hospital mortality (22.5% vs. 15.0%; p = 0.14) or outcome-free days (4.9 days vs. 4.5 days, p = 0.55). The use of an EDOR is associated with decreased time to hemorrhage control as evidenced by the decreased time to incision, blood transfusion requirement, ICU LOS, hospital LOS, and ventilator days. These findings support DOR for patients sustaining operative abdominal trauma. Therapeutic/Care Management, Level III.